Results of treatment of aseptic necrosis of the femoral head with vascularized bone graft.

Osteonecrosis of the femoral head with deformity was treated with vascularized iliac crest grafts or with free microanastomosed fibular grafts in 20 young adults (22 hips). The clinical and radiographic results at two years and five years are presented. The overall results are promising. The hips gradually improved both clinically and radiographically during the first two years. The changes after that were less significant. The Danielsson pain score decreased from 91 (preoperative) to 28 during the first two years and declined to 18 during the second period of observation. Walking ability (measured by the Merle d'Aubigné method) improved from a preoperative score of 46 to 29 during the first two years and then to 10 during the three following years. The range of joint movement first decreased, and then increased again during the second follow-up period. There was radiographic evidence of graft fusion to the surrounding bed in 18 hips during the first two years and in all 12 hips of the second series with a two to five year follow-up. Homogenization of the femoral head was observed in 18 cases in the first two year follow-up series and in 10 in the second two to five year follow-up series. Stabilization of the femoral head shape was observed in 19 hips in the first series and in 12 hips in the second series. During the second period of observation, 9 patients were able to return to their former occupation and 2 were retained for new occupations.